Commonwealth of Massachusetts
Executive Office of Health and Human Services
Office of Medicaid
www.mass.gov/masshealth

Eligibility Operations Memo 11-09
November 15, 2011

TO:	MassHealth Eligibility Operations Staff

FROM:	Amy Andrade, Director, Member and Provider Services

RE:	Medex Premium Rate Increase
		

Introduction	
Blue Cross and Blue Shield of Massachusetts has received approval from the Division of 
Insurance on the following premium rates for all of its nongroup Medex plans: Medex Gold, 
Medex Silver, Medex Standard, Medex Basic, Medex Bronze, Medex Core, Medex Core Plus, 
Medex Basic without Pharmacy, and Medex Core Plus without Pharmacy, effective January 1, 
2012.

Rate Changes and PACES Codes
The Medex plans, PACES codes, old and new quarterly rates, and new 
monthly premiums appear in the chart below. The new monthly premium is the amount 
allowed as a patient-paid amount (PPA) deduction after other deductions that get priority 
under MassHealth regulations at 130 CMR 520.026. Fees for special billing arrangements that 
cause a premium to exceed these amounts are not allowable PPA deductions.



Medex Plan		PACES 	2011 Quarterly 	2012 Quarterly	2012 Monthly
			Code	Rate		Rate		Premium

Basic 			1 	$1,104.84 	$1,141.11 	$380.37
Bronze 			2 	$544.23 	$558.33 	$186.11
Gold 			3	$2,015.10 	$2,063.49 	$687.83
Standard 		4	$1,453.05 	$1,501.47 	$500.49
Core Plus 		6	$467.10 	$479.79 	$159.93
Core 			7	$286.53 	$297.87		$99.29
Silver 			8	$1,477.95 	$1,564.23 	$521.41
Basic without Rx	B 	$549.39		$601.71 	$200.57
Core Plus without Rx 	C 	$376.32 	$395.43 	$131.81


Important: The correct use of PACES codes prevents values greater than the maximum premium amount 
from being entered. Workers can enter an amount that is less than the current maximum 
premium amount to calculate a retroactive PPA.

Medex Basic, Gold, Silver, Core Plus, Standard, Basic without Pharmacy, and Core Plus without 
Pharmacy are closed to new members. 

System Changes
Community MassHealth cases with Medex coding will be updated with the new premium 
amounts for both MA21 and PACES.

Long-term-care MassHealth cases with Medex coding will also be updated with the new 
premium amounts by the system. MassHealth will recalculate the PPAs for these cases in 
January 2012.

PPA Notices	
During the month of December 2011, MassHealth will mail system-generated notices containing 
information about the new PPAs to affected long-term-care members, eligibility representatives, 
and nursing facilities.

Questions	
If you have any questions about this memo, please have your MEC designee contact the Policy 
Hotline.